Phaeohyphomycosis of the face caused by Exophiala oligosperma

A 57-year-old previously healthy woman who works in the fish-processing industry presented with a 1-year history of a slightly pruritic, hyperkeratotic, brownish, erythematous lesion of the left cheek measuring 5 x 5 mm in diameter. Histopathology revealed granuloma formation in the superficial dermal layer by multinucleated giant cells that contained pale-brown septate hyphae. Periodic acid-Schiff stain showed many hyphae and catenate spores within the multinucleated giant cells. Tissue specimens and skin scrapings were obtained and incubated on mycosel agar, yielding black, velvety colonies that were morphologically identified as belonging to Exophiala species. Sequence analysis of the internal transcribed spacer region of the ribosomal RNA gene showed 99-100% homology to Exophiala oligosperma sequences. This report describes a rare case of phaeohyphomycosis of the face caused by E. oligosperma.